Fulminant myocarditis (FM) is an acute and severe form of myocarditis with rapid progression and poor clinical outcomes in the absence of acute or chronic coronary artery disease. Electrocardiogram (ECG) abnormalities can provide preliminary clues for diagnosis; however, there is a lack of systemic descriptions on ECG changes in FM populations. Thus, a retrospective analysis of 150 consecutive FM patients and 300 healthy controls was performed to determine the characteristic ECG findings in FM. All patients included had markedly abnormal ECG findings. Specifically, 83 (55.33%) patients had significantly lower voltage with remarkably decreased QRS amplitudes in all leads compared with healthy controls (p < 0.01), and 77 (51.33%) patients had a variety of arrhythmias with lethality ventricular tachycardia/ventricular fibrillation in 21 (14.00%) patients and third-degree atrioventricular block in 21 (14.00%) patients, whereas sinus tachycardia was only found in 43 (28.67%) patients with the median heart rate (HR; 88.00 bpm, IQR: 76.00–113.50) higher than that of controls (73.00 bpm, IQR: 68.00–80.00) (p = 0.000). Conduction and repolarization abnormalities were common in patients. A longer QTc interval (452.00 ms, IQR: 419.00–489.50) and QRS duration (94.00 ms, IQR: 84.00–119.00) were observed in patients compared to controls (QTc interval = 399.00 ms, IQR: 386.00–414.00; QRS duration = 90.00 ms, IQR: 86.00–98.00) (p < 0.05). Additionally, HR > 86.50 bpm, QTc > 431.50 ms, and RV5 + SV1 < 1.715 mV can be used to predict FM. Thus, marked and severe ECG abnormalities provide preliminary clues for the diagnosis of FM.

Pulsed field ablation (PFA) is a new ablative method for the therapy of arrhythmia. Recent preclinical and clinical studies have already demonstrated the feasibility and safety of PFA for the treatment of atrial fibrillation (AF). However, the application of PFA may not be limited to the above fields. There are some data on the application of PFA on ventricular arrhythmias (VAs), such as ventricular fibrillation (VF) and ventricular tachycardia (VT). Further, a case report about PFA has been published recently, in which PFA was successfully applied to the ablation of premature ventricular contractions (PVCs) from the right ventricular outflow tract. Thus, we aimed to review recent research findings of PFA in ventricular ablation and evaluate the possibility of its application in VAs.

Pulmonary vascular remodeling, characterized by the thickening of all three layers of the blood vessel wall, plays a central role in the pathogenesis of pulmonary hypertension (PH). Despite the approval of several drugs for PH treatment, their long-term therapeutic effect remains unsatisfactory, as they mainly focus on vasodilation rather than addressing vascular remodeling. Therefore, there is an urgent need for novel therapeutic targets in the treatment of PH. Nuclear factor erythroid 2-related factor 2 (Nrf2) is a vital transcription factor that regulates endogenous antioxidant defense and emerges as a novel regulator of pulmonary vascular remodeling. Growing evidence has suggested an involvement of Nrf2 and its downstream transcriptional target in the process of pulmonary vascular remodeling. Pharmacologically targeting Nrf2 has demonstrated beneficial effects in various diseases, and several Nrf2 inducers are currently undergoing clinical trials. However, the exact potential and mechanism of Nrf2 as a therapeutic target in PH remain unknown. Thus, this review article aims to comprehensively explore the role and mechanism of Nrf2 in pulmonary vascular remodeling associated with PH. Additionally, we provide a summary of Nrf2 inducers that have shown therapeutic potential in addressing the underlying vascular remodeling processes in PH. Although Nrf2-related therapies hold great promise, further research is necessary before their clinical implementation can be fully realized.

Background: Diabetes significantly increases the risk of atrial fibrillation (AF), but identifying high-risk individuals remains a clinical challenge. This study aimed to improve AF risk stratification in diabetic patients through a combination of clinical modeling and untargeted metabolomic analysis. Methods: A clinical risk score was developed using data from the National Health and Nutrition Examination Survey (NHANES) and validated in an independent cohort from Tongji Hospital. Its association with long-term outcomes and its ability to predict AF recurrence after catheter ablation were assessed in follow-up studies. Additionally, untargeted plasma metabolomics was performed in a subset of diabetic patients with and without AF to explore underlying mechanism. Results: The risk score showed good predictive performance in both the development and validation cohorts and was significantly associated with clinical prognosis. When combined with left atrial diameter and AF type, it also improved the prediction of AF recurrence after ablation. Metabolomic profiling revealed notable disturbances in energy metabolism, heightened inflammatory activity, and elevated stress responses in AF patients, indicating a distinct metabolic risk profile. Conclusions: This study provided two approaches to identify high-risk AF in diabetic patients, discussed the underlying pathophysiological mechanisms, and compared their characteristics and applications. And integrated strategies could improve AF risk stratification and personalized management in the diabetic.